Objective: To determine accuracy of SOFA score in predicting in-hospital mortality of elderly patients with SIRS criteria. Material and Method: A prospective observational study at tertiary care hospital. 102 elderly patients (>60 years) with 2 or more SIRS criteria are included, SOFA score calculated at admission and at 48 hours. Association of SOFA score with mortality was assessed. Results: Mean age of patients is 69.7 years and mortality is 35.29% (36 out of 102 died). 17(89.47%) patients died out of 19 patients having SOFA score >10. With SOFA 6-10, 14(41.17%) patients died and 5(11.62%) patients died in SOFA group 1-5 and all 6 patients survived with SOFA score 0. Result is statistically significant (p value 0.005). Mean SOFA score is higher in non-survivors (9.81±4.006) than survivors (4.29±3.076) at admission. Mean SOFA score at 48 hours in non-survivors is 11.43±4.64 v/s 2.20±2.366 in survivors and mean DELTA SOFA in non survivors is 2.65±3.892v/s -2.09±2.104 in survivors. Conclusion: Higher SOFA score at admission and high mean SOFA at admission, 48 hour and high mean DELTA SOFA is associated with increase probability of mortality so we can conclude that SOFA score can predict in-hospital mortality in elderly patients.